| NPI | 1578769535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NJ 22DI02411900) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: PA DS037212) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2009-07-22 |